Be A Healthier and Leaner T1 Diabetic

When I was a teenager (before T1 diabetes), I was more energetic, leaner, and healthier. Now that I’m 41, I still strive for these qualities, but age and Diabetes are formidable obstacles. So, how do I get back there? In theory, I’m looking for the fountain of youth which is pure fantasy. In practice, however, there are some ways that I (we) can get closer to those goals despite living with T1.

Here’s the 30,000 foot overview of how to do it:
1. Keep your BG between 70 – 100 at all times.
2. Get 8 – 10 hours of quality sleep every night.
3. De-stress as much as possible.
4. Balance your hormones.
5. Exercise
Ok, I know this sounds like a pipe dream. Even if these steps seem impossibly out of reach, they are worth striving for. If you want to look and feel extraordinary, you have to act extraordinary. Also, I’m not a fan of setting unattainable goals. These five steps are doable, but they take some work. So here are some guidelines to help you do it.
1. How to keep your BG between 70 – 100
     I have tested BG levels of many of my healthy (non-diabetic) friends to see what happens to their BG levels after meals. Of the dozens of volunteers, only one registered a BG levels over 100. The young woman, who will remain anonymous, measure 110 on my BG meter after drinking several syrupy sweet margaritas along with a bowl of chips and guacamole. Young, healthy people look great, in part, because they can metabolize the heck out of some serious carbs without creating a giant bolus of insulin. Young people can get away with eating pure crap all day because their bodies are sensitive to insulin and generally have better overall hormonal profiles (I’ll talk about this one in step 4). By keeping our BG in the healthy range, we can give our bodies some room to naturally adjust other hormones into a younger, more healthful zone.
     In terms of nutrition, I have found ways to keep BG stable by eating a large portion of my calories from healthy fats like grass-fed butter, coconut oil, eggs, avocados, grass-fed beef, wild fish, and some healthy oils like olive oil and macadamia nut oil (good for cooking – up to about 450 degrees F). If you are a vegan or vegetarian, you’ll need to substitute fats and proteins that you’ve found friendly to your BG, but do your best to avoid industrial seed oils like soybean, sunflower, cottonseed,safflower, and canola. 
The other night, I developed a severe headache around midnight. I knew it was going to be a bad one so I took two Excedrin tablets. This medication has caffeine in it ( a stimulant) so I wasn’t completely shocked to find my BG at 160 upon waking. My point here is there will always be accidental excursions outside the targeted range of 70 – 100. But don’t let them ruin the whole day. Make the appropriate adjustments and get back into the healthy range. For me, I went for a long walk and drank lots of water. This restored my BG back to 70 before lunch.
Here are some suggestions to keeping BG low and stable.
     a. Avoid carbs in the morning and don’t skip breakfast. If you’re generally not hungry in the morning, try bulletproof coffee. I find that even a tiny bit of carbs in the morning is difficult to control. Though trial and error, I’ve found that 2 pastured eggs cooked in grass-fed butter along with half an avocado and a cup of coffee keeps me going till lunch. You have to play with the macro nutrients to find the formula that works best for you. 
     b. If your sugar gets low and you can’t wait till the next meal, eat a little fruit. I know a few diabetics who delight in low BG reading on their meters because they see it as a license to eat a whole pie. It’s amazing how little will get your BG from 62 up to 82 so you can make it till the next meal. 
     c. Eat lots of non-starchy veggies at lunch and dinner. I typically throw some wild salmon or sardines on top to get some fat and protein. Use a little olive oil, salt, and pepper for salads as apposed to seed oils. Be careful at restaurants, they often use the cheapest oil available for dressings and for cooking. I often bring my own dressing if I go out for lunch. 
     d. Error on the side of smaller meals and smaller doses of fast acting insulin. This argument goes along with the “Law of Small Numbers” argument from Dr. Bernstein’s book, ‘The Diabetes Solution’. Try to eat meals that require little to no fast acting insulin. 
     d. Stay active after meals. Try going for a short walk or doing the dishes. It’s amazing how little it takes to keep BG levels under 100 after a meal simply by moving around a little. If you have to sit, recline. I have found it easier to control BG after a meal by reclining in an easy chair or laying on the floor. Getting into a car is probably the worst thing to do after eating. If you must get into a car after a meal, try lifting your feet one inch off the floor engaging your abs for 10 seconds up and 10 seconds down. This goes unnoticed by the rest of the people in the car and is amazingly effective. If you’re the one driving, engage your abs without lifting your feet off the pedals. If you have to go right back to work behind a computer after a meal, look into an adjustable stand up desk, one that you can adjust easily to go from sitting to standing. I recently purchased such a desk from Ergotron. I go back and forth between sitting and standing every 30 minutes or so and this desk makes it really easy.
     e. Time your carbohydrates around exercise. This will help ensure calories consumed go into tissue that is demanding glucose. This would be your muscles, heart, brain, etc. And not into fat. 
     f. Stay hydrated. I believe this has a calming effect and dehydration is one of the fastest ways I know of leading to BG instability.
     g. Check your BG often. If you don’t have a CGM, do whatever it takes to cajole your doctor into prescribing at least eight strips per day. We’ve all heard the old adage, “you can’t manage what you don’t measure”.
     h. Once you find all the delicious foods and spices that don’t hijack your BG, I think you’ll find it’s very high in fat, moderate in protein, and low in carbohydrates. This kind of diet seems scary at first, especially if you still adhere to the ADA recommended guidelines which is low fat, high carb. I tried every variation of this out dated and scientifically unproven nutritional approach and always found myself unsatisfied and riding a BG roller coaster. If you stick with a high fat, low carb (hflc) diet for several weeks, I think you’ll find some great benefits (even for those athletes out there). As you reduce carbs, your body will rely more and more on fat for fuel. I have found that I can exercise for an hour with reduced danger of crashing BG requiring carbohydrate replacement. I can also go several hours between meals without hunger. Best of all, keeping BG low and stage is far easier than with a high carb diet. 
          i. Finally, there is some evidence that cycling the carbs could be helpful. One night a week or twice a month, I like to go a little crazy and eat whatever I feel like and try to eat lots of carbs. I do this to make sure my body’s ability to metabolize carbs doesn’t shut down. 
2. Get more sleep. 
     This one is ridiculously important and the least understood. I have improved my sleep significantly over the years, but I still have problems. Here are some of the tricks I’ve found to be helpful. If you do a google search for “sleep hacking”, you’ll find a dizzying array of supplements and lighting tricks to help regulate your natural sleep rhythms. To be honest, I’ve tried a great many things and I still struggle to remain asleep during the middle hours of the night between 11 and 3. Most of the time, however, I fall asleep in no time and wake up relatively refreshed.
     a. Make it chilly in your bedroom. I’ve seen studies pinning the ideal temperature between 67 – 70 degrees F. Play around with this one and find the best compromise between you and your bedroom buddy. 
     b. Eliminate screen time before bed. Lights from computers, phones, TV’s, etc., can screw up natural hormone cycles making it difficult for some to fall asleep. 
     c. Get on a schedule. Train your body to go to bed and wake up around the same time each day. I’m generally in bed by 9pm. If I’m going to get 8 hours of sleep, wake up feeling refreshed for a good workout, and be at work on time, this is a must.
     d. Reduce or eliminate alcohol during the week or whenever you want your brain to function well. I have found that one glass of wine at night with dinner does not affect my sleep. Two and up starts to affect (negatively) the amount of time I spend awake in the middle of the night.You should explore your own personal threshold with regard to alcohol.
     e. Try to get lots of fat in your dinner. This will help maintain BG levels during the night. I have also found a little dark chocolate to be magical. If I check my BG at 8:30pm and find it to be 92, I know my BG will remain stable through the night assuming I had a well balanced dinner containing a robust amount of fat, fiber, and protein. If, however, my BG is 72, there is a reasonable chance that I will go hypo at night and disturb my quality sleep. By eating only 1.5 – 2 oz. of dark chocolate (85%), I can keep my BG afloat all night. And, it’s delicious!
     f. If your BG levels rise at night, try experimenting with Alpha Lipoic Acid and/or Creatine. These supplements have been shown to help normalize BG levels by increasing insulin sensitivity. 
3. De-stress.
     I think we all know what our stress triggers are, but feel powerless to avoid them. If we devote a little thought to these stressors at home and at work, we can often attenuate them significantly or eliminate them all together. I rely heavily on swimming, walking, yoga, pilates, audiobooks, and podcasts. Figure out what time of day you deal with certain stressors better than others. For example, in our jobs, we all deal with emails. Try responding to emails twice per day and turn off email alerts. Time these two email excisions at times when you’re relatively relaxed and non-frantic and don’t let the people at the other end of those emails to dictate the level of drama.
4. Balance your hormones.
     I’m still learning all the other hormones that get screwed up with T1. Clearly, our ability to make insulin is compromised. I even found a couple studies indicating that glucagon balance is deranged and can even operate in reverse – secreting glucagon when BG is high! Therefore, T1’s need to be diligent to get there hormone levels checked, including sex hormones and fix what can be fixed. A HFLC diet, described above, and in Dr. Bernstein’s book can help.
5. Exercise
     I tend to use exercise as a tool as apposed to a daily routine. For example, after dinner each night, my family and I go for a short 15 – 20 minute walk. I have found this reduces or eliminates the BG spikes following our evening meal. Whenever possible, I try to walk after every meal. I use stretching as stress reduction. I have a 30 minute routine I run through 4 -5 times per week. In addition to stress reduction, it’s helpful for injury prevention as well. My main activity is swimming. I workout with a masters team 3 – 4 times per week. This activity keeps me happy and socially engaged. It is strenuous exercise and can be easily abused so don’t go overboard on things like cross fit and running. Remember, exercise is a form of stress and can elevate BG. Lastly, I do some resistance training with heavy weights at the gym, 1 – 2 times per week. 
Swimming and weight lifting are forms of H.I.I.T (high intensity interval training). I believe these forms of exercise are important for everyone to incorporate into their schedule, but vital for T1’s. HIIT has two key benefits.
     1. Build muscle – more lean mass will boost metabolism and insulin sensitivity improving BG normalization. 
     2. Balance hormones – A short intense effort can boost testosterone and HGH levels. Don’t freak out women, this will not turn you into a muscle head. Balancing testosterone and HGH will also help modulate other sex hormones. Remember, our hormone profile changes over the years which is one reason we can’t live and eat like we did when we were younger.
     Exercise will impact your need for insulin so please check it often. And finally, don’t under estimate the power of an easy stroll after meals. It doesn’t need to be an intense power walk. My family and I call it the mozy. 

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